Fertility-sparing treatment for low-grade endometrial stromal sarcoma

BACKGROUND: Little is known about the oncologic results of patients with low-grade endometrial stromal sarcoma (LGESS) with fertility preservation. This study investigated the prognosis of fertility-sparing surgeries and relevant obstetrical outcomes. METHODS: All eligible patients in the study center were retrospectively reviewed if they consented to surgical treatment for primary LGESS from February 2012 to June 2019 in the study center. Follow-up of fertility and oncologic outcomes was carried out until June 1, 2020. RESULTS: Among 135 patients who underwent surgical therapy for primary uterine LGESS, 21 (15.6%) and 42 (31.1%) underwent fertility-sparing surgery and ovarian preservation, respectively. After a median follow-up of 38.5 (range 5-98) months, differences were detected in the recurrence rates among patients with and without fertility-sparing surgery (47.6% vs 15.8%, p = 0.002) or with and without ovarian preservation (42.9% vs 10.8%, p < 0.001). Fertility-sparing surgery and ovarian preservation significantly increased the risk of recurrence in the entire cohort (hazard ratio HR 3.5 and 5.2, 95% confidence interval CI 1.6-7.6 and 2.4-11.3, p = 0.002 and < 0.001) and in stage I patients (HR 2.6 and 3.1, 95% CI 1.0-6.4 and 1.3-7.4, p = 0.041 and 0.011). No factor was found to be associated with increased mortality risk. Among the 9 patients who attempted pregnancy, 7 (77.8%) achieved 8 live births. All three advanced-stage patients who underwent fertility-sparing surgery experienced recurrence without successful conception. CONCLUSIONS: Fertility-sparing surgery for LGESS results in a significantly increased risk of recurrence but not mortality and has promising results in terms of live births in stage I patients.